Provider Demographics
NPI:1073507604
Name:SKINNER, MICHAEL A (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:SKINNER
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 OVERLOOK CIR
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3291
Mailing Address - Country:US
Mailing Address - Phone:615-370-9486
Mailing Address - Fax:615-370-8681
Practice Address - Street 1:213 OVERLOOK CIR
Practice Address - Street 2:SUITE B-4
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3291
Practice Address - Country:US
Practice Address - Phone:615-370-9486
Practice Address - Fax:615-370-8681
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics